'Fourth trimester' care for new mothers recommended

"We want to replace the one-off checkup at six weeks with a period of sustained, holistic support for growing families," said Dr. Alison Stuebe, lead author of new guidelines from the American College of Obstetricians and Gynecologists.

By

Allen Cone

A "fourth trimester" of medical care of new mothers is now recommended by the the American College of Obstetricians and Gynecologists. Photo by Prexels/pixabay

April 25 (UPI) -- The American College of Obstetricians and Gynecologists is recommending a "fourth trimester" of medical care for mothers after birth.

The group's task force this week issued an 11-page report, called "Optimizing Postpartum Care," on ways for providers, insurers and patients to work together to improve care for new moms.

"To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs," the guidelines propose.

Specifically, instead of waiting six weeks for a mother's first postpartum checkup, ACOG recommends a "fourth trimester" of three months of treatment for mothers of newborns. The nine-month pregnancy period is divided into trimesters.

"New mothers need ongoing care during the 'fourth trimester,'" lead author Dr. Alison Stuebe said in an ACOG post on Twitter. "We want to replace the one-off checkup at six weeks with a period of sustained, holistic support for growing families."

Ideally, care would begin within three weeks of giving birth for a "comprehensive postpartum visit."

The guidelines state that the comprehensive visit should include a full assessment of physical, social and psychological well-being. This includes mood and emotional well-being, infant care, sexuality, contraception, sleep and fatigue, physical recovery from birth, chronic disease management and health maintenance.

ACOG is urging providers to emphasize to patients the long-term health risks associated with pregnancy complications such as preterm delivery, preeclampsia and gestational diabetes.

"This revised guidance is important because the new recommended structure is intended to consider and cater to the postpartum needs of all women, including those most at risk of falling out of care," Dr. Haywood L. Brown, president of ACOG, said in a press release.

About 40 percent of women do not attend a postpartum visit, and the figures are lower for poorer families.

"The baby is the candy, the mom is the wrapper," Stuebe, who teaches in the department of obstetrics and gynecology at the University of North Carolina School of Medicine, told ProPublica. "And once the candy is out of the wrapper, the wrapper is cast aside."

More than 700 women die every year in this United States from causes related to pregnancy and childbirth and more than 50,000 suffer life-threatening complications, according to Centers for Disease Control and Prevention. For black mothers, the death rate is three to four times that of white women.

Forty-five percent of pregnancy-related deaths occur within 42 days of the end of a pregnancy and 17.5 percent occur from 43 days to one year after the end of a pregnancy, according to the Centers for Disease Control and Prevention.

The most severe pregnancy complications are a heart attack or hemorrhage, according to the CDC.

"As the nation's leading group of physicians providing health care for women, we must use the postpartum period as a gateway opportunity to counsel women on long-term health implications," Brown said.

In many cases, insurance only covers one postpartum visit for moms. The medical group urged "insurance coverage policies should be aligned to support this tailored approach to 'fourth trimester' care."

"By providing comprehensive, woman-centered care after childbirth, obstetrician-gynecologists and other obstetric care providers can enable every woman to optimize her long-term health and well-being," ACOG said in the new guidelines.